CPT 97750: Physical Performance Evaluation and Functional Assessment - OpenPayer

Summary & Overview

CPT 97750: Physical Performance Evaluation and Functional Assessment

CPT code 97750 designates a formal physical performance evaluation in which a clinician assesses musculoskeletal function and activities of daily living and documents findings in a written report. This evaluation is used to quantify functional capacity, guide care planning, and support clinical and administrative decisions. Nationally, the code matters for standardizing how functional assessments are billed across rehabilitation and outpatient settings, affecting coverage, utilization oversight, and care coordination.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the code’s clinical role, comparisons to related evaluation and testing codes, common settings where the service is delivered, and payer coverage considerations. The publication summarizes typical use cases—such as assessing gait, transfer ability, endurance, and task-specific performance—and situates 97750 alongside related rehabilitation services.

The analysis provides benchmarks for utilization patterns and common billing contexts, explains documentation elements tied to the written report requirement, and highlights clinical scenarios where the evaluation is commonly applied. Policy and coverage nuances from major national payers are summarized to inform coding accuracy and administrative workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicare97750CPTPhysical performance evaluationFunctional assessmentRehabilitation servicesOutpatient rehabCoding and billingClinical documentation

Billing Code Overview

CPT code 97750 describes a physical performance evaluation in which the provider assesses a patient’s musculoskeletal and functional capacity through standardized tests and observation of activities of daily living. The service includes evaluation of physical performance and completion of a written report documenting findings and functional implications.

Service type: Functional performance assessment / Physical performance evaluation

Typical site of service: Outpatient rehabilitation clinic, outpatient hospital department, or other ambulatory care settings where physical or occupational performance testing is performed

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient presents to an outpatient Physical Medicine & Rehabilitation clinic with progressive difficulty walking and pain in both knees and the lower back. The patient reports worsening ambulation over 3 months, subjective generalized muscle weakness, and recurrent falls. The provider (physical medicine & rehabilitation physician, physical therapist, or occupational therapist) performs a structured physical performance evaluation to assess musculoskeletal strength, range of motion, gait, balance, transfers, and activities of daily living. The evaluation includes standardized tests (timed up-and-go, gait speed, 5-times sit-to-stand), muscle strength grading, pain-provocation maneuvers, observation of stair negotiation and community ambulation tasks, and review of prior imaging and functional limitations. The clinician documents findings and completes a written report summarizing functional capacity, safety concerns, assistive device needs, and measurable goals. This service supports rehabilitation planning, disability determination, assistive technology recommendations, or pre‑operative functional assessment. Typical sites of service include outpatient rehabilitation clinics, hospital-based outpatient departments, long-term care facilities, and home health settings when permitted.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional component of a split-service (e.g., interpretation or report) if technical component is billed separately.

CPT 97763: Subsequent Orthotic and Prosthetic Training

cpt-97760-orthotic-management-and-training-initial-encounter

CPT 97760: Orthotic Management and Training, Initial Encounter

97755

CPT 97755: Assistive Technology Assessment, Timed 15-Minutes

97761

CPT 97761: Prosthetic Training for Upper/Lower Extremity(s)

97763

CPT 97763: Orthotic and Prosthetic Management, Subsequent Encounter

cpt-97761-prosthetic-management-training-initial-15-min

CPT 97761: Prosthetic Management and Training, Initial 15 Minutes

cpt-97755-assistive-technology-assessment

CPT 97755: Assistive Technology Assessment and Device Selection

97750

CPT 97750: Physical Performance Test or Measurement, Outpatient Rehabilitation

97760

CPT 97760: Orthotic Management and Training, Initial Encounter

Taxonomy Code	Specialty	Notes
`225100000X`	Physical Therapist	Performs standardized functional tests, gait and balance assessments, documents performance, and contributes to the written report.
`225200000X`	Occupational Therapist	Focuses on activities of daily living, transfers, and home safety evaluations; documents functional capacity and task-specific limitations.
`208100000X`	Physical Medicine & Rehabilitation Physician	Provides medical evaluation of functional capacity, coordinates interdisciplinary assessment, and completes formal written reports for disability or surgical clearance.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.5`	Low back pain	Low back pain can impair gait, transfers, and functional mobility assessed during the performance evaluation.
`M25.561`	Pain in right knee	Right knee pain may limit ambulation, stair negotiation, and balance; identified deficits guide intervention and device needs.
`M25.562`	Pain in left knee	Left knee pain similarly affects gait and functional tasks; laterality informs targeted testing and recommendations.
`R26.2`	Difficulty in walking, not elsewhere classified	Directly indicates impaired ambulation; the evaluation quantifies walking limitation and fall risk.
`M62.81`	Muscle weakness (generalized)	Generalized weakness impacts endurance, transfers, and safety; testing documents severity and functional impact.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97161`	Physical Medicine and Rehabilitation Evaluation (low complexity)	May be performed before or instead of the functional performance evaluation to establish history, examination, and clinical decision-making; documents baseline and plan.
`97760`	Orthotic(s) management and training, initial encounter	Related when the performance evaluation identifies need for assistive or orthotic devices; supports recommendation and fitting workflow.

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